June 28, 2012

Hospitals, Physicians and Others Continue to be Impacted with Supreme Court Affirmation of Affordable Care Act

Tax & Business

Marcum LLP National Healthcare Industry Group partner David H. Glusman commented on the Supreme Court’s landmark affirmation of the Affordable Care Act.

Certain aspects of the law that have already gone into effect will stay in place. For example and of particular import to the “Medicare Generation” is the additional discount on brand-name drugs in the Medicare “donut hole” which went into effect in 2011. In addition, the accountable care organizations that were in the law and which are encouraged and partially financed will continue to go forward.
The current trend of hospital and physician organizations working more closely together and, in some cases, reorganizing into single units, will go forward. This will be particularly true in hospital and physician co-management agreements as well as hospitals working more closely in other ways with physicians for better care and cost outcomes.
The hospitals that are most active in working with the physicians will be at the forefront of benefiting from the Affordable Care Act. Examples include hospitals that have already put in place agreements with physician groups that will get patients in and out of the Emergency Room more quickly, come to a resultant diagnosis on chest pain more quickly, and reduce costs in hospital setting by working closely with physicians who are technically independent
Thousands of small businesses that otherwise would find providing health insurance “too expensive” are going to benefit from the additional tax credits allowing them to provide health insurance benefits for their workers.
Tens of thousands of young adults would otherwise have no insurance, or have to get insurance on their own. Under the Affordable Care Act will be able to remain on their parents’ plans until they turn 26 years old. The Law will also create $5 billion worth of programs to allow employers to provide health insurance coverage for “early retirees” (those who are not yet eligible for Medicare).
The health insurance market will certainly be impacted with the provision that requires insurance companies to justify premium increases to the states and prohibits the insurance companies that are not in compliance will not be able to participate in the new health insurance exchanges which will now come into place in 2014.
Many of the low-income individuals will now be able to get on Medicaid where they were previously (before the Affordable Care Act) ineligible. This will be funded with the states able to receive matching funds from the Federal government for including certain low-income individuals and families under Medicaid where funds were not previously available from the Federal government for this.
Certain of the preventive health care issues that went into effect in 2011 for Medicare recipients will now stay in place. Previously, preventive care such as “annual wellness visits” were not covered whereas, beginning in 2011 under the Affordable Care Act they are covered and will continue to be so. In addition, the 2013 provisions for preventive care under Medicaid will, for the first time, allow that population to get preventive care under the government program.
Physicians will continue to be able to be paid a stipend for successfully implementing electronic medical records which generally increase the efficiency of the physician’s office, reduce the likelihood of errors and missed diagnoses and test results, as well as allowing for better use of the patient’s medical record across multiple platforms, and providing for less likelihood of missed medical issues when patients are visiting different physicians either because of geography or different medical needs.